Acute mitral regurgitation caused by papillary muscle rupture (PMR) is a severe complication often associated with acute myocardial infarction. A 41-year-old male developed acute mitral regurgitation due to posterior papillary muscle rupture during catheter ablation for supraventricular tachycardia. The rupture likely occurred when the chordae tendineae became entangled during catheter manipulation. The patient, a Jehovah's Witness, refused blood transfusion but accepted diluted autologous blood, a cell saver, and cardiopulmonary bypass. The ruptured posterior papillary muscle and anterior leaflet (A2) were excised, and mitral valve replacement was performed using a mechanical valve. Postoperatively, the patient recovered without mechanical circulatory support or blood transfusion and was discharged in good condition. This case highlights the rare complication of papillary muscle rupture during catheter ablation.

A 74-year-old man had been taking warfarin for atrial fibrillation, but warfarin was discontinued due to upper gastrointestinal bleeding. One week later, left hemiplegia occurred, and cranial magnetic resonance imaging revealed multiple cerebral infarctions. Systemic examination revealed thrombi in both atria as well as duodenal cancer. Because all of the thrombi in both atria were larger than 30 mm in diameter, the risk of embolism or sudden death was assumed to be high. Although the use of cardiopulmonary bypass for cancer patients is controversial, bilateral atrial thrombectomy was performed 4 weeks after cerebral infarction onset because reasonable survival duration was expected with surgery for duodenal cancer after thrombectomy and further treatment. The timing of and indications for surgery in this case are discussed.